Abstract          Background: Acute ischemic stroke (AIS) is a common cause of mortality and morbidity all over the world. Cerebral ischemia is a pathology that stems from a decrease in cerebral perfusion. Computed Tomography Perfusion (CTP) is an additional method to the conventional non-enhanced CT (NECT) that could be performed by using developed softwares, in a short period of time and with a low risk of complications. CT angiography is highly sensitive in detection of arterial anatomy and occlusion of intracranial vessels. CT angiography can be used for initial imaging of patients with suspected stroke as screening test for internal carotid artery stenosis. In the present study an effort has been made to study the effectiveness of initial NECT versus combined NECT plus CT Perfusion in detection of cerebral ischemia. Material and Methods: A total of 1325 patients clinically suspected of having stroke were included in the study. Among 1325 cases, 55 patients with hemispheric symptoms of ischemic stroke were enrolled and subjected to non enhanced CT followed by perfusion analysis (n=25) or CT angiography. Results: Sensitivity and specificity of initial NECT as a modality in detecting ischemia are 55.56% and 100% respectively. Whereas, sensitivity and specificities of CT perfusion in detecting ischemia are 83.33% and 100% respectively. The ability to diagnose hyper acute stroke is superior with CT perfusion as compared to initial NECT. Discussion: We actually recommend that the imaging protocol for stroke patients should combine all three which can include plain CT, CT perfusion and CT angiography at one sitting if possible than including Doppler and MRI.